| NPI | 1609929371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 35-099606) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MA 227967) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-12-09 |